[The new ESC guidelines for non-ST-elevation acute coronary syndromes: one direction, many ways, clinical wisdom].

: The 2011 edition of the ESC guidelines on non-ST-segment elevation acute coronary syndromes (NSTE-ACS) maintains the approach strongly based upon risk stratification, following the concept that "the higher the risk of ischemic events, the larger will be the benefit of an aggressive pharmaco-interventional approach". This concept applies both to the indication and timing of angiography/revascularization and to the choice of concomitant pharmacological therapies. The proofs of efficacy of the most recent drug treatments are solid, but the choice among the several available options and the evaluation of the efficacy/safety ratios in patient subsets require clinical wisdom, especially for the management of the most complex and frail patients. The indication for performing coronary angiography within 24h in high-risk patients would imply extending to NSTE-ACS patients the networks already in place for primary percutaneous coronary intervention in ST-elevation myocardial infarction.